Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

BETA-2 GLYCOPROTEIN 1 AB, IGG (163882)

Facility

$41.00

Service Code	CPT 86146
Hospital Charge Code	4086146
Hospital Revenue Code	307
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare	$36.90
Rate for Payer: BCBS MT CHIP	$36.90
Rate for Payer: BCBS MT Closed Plan Network	$38.95
Rate for Payer: BCBS MT HealthLink	$36.90
Rate for Payer: BCBS MT Medicare	$36.90
Rate for Payer: BCBS MT POS	$38.95
Rate for Payer: BCBS MT Traditional	$41.00
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna Commercial	$38.95
Rate for Payer: Cigna Medicare	$36.90
Rate for Payer: Medicaid All Medicaid	$37.72
Rate for Payer: Medicare All Medicare	$28.70
Rate for Payer: Monida Allegiance	$38.95
Rate for Payer: Monida First Choice Health	$39.77
Rate for Payer: Monida Montana Health Co-op	$38.95
Rate for Payer: Monida PacificSource	$38.95

BETA-2 GLYCOPROTEIN 1 AB, IGG (163882)

Facility

$41.00

Service Code	CPT 86146
Hospital Charge Code	4086146
Hospital Revenue Code	307
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare	$36.90
Rate for Payer: BCBS MT CHIP	$36.90
Rate for Payer: BCBS MT Closed Plan Network	$38.95
Rate for Payer: BCBS MT HealthLink	$36.90
Rate for Payer: BCBS MT Medicare	$36.90
Rate for Payer: BCBS MT POS	$38.95
Rate for Payer: BCBS MT Traditional	$41.00
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna Commercial	$38.95
Rate for Payer: Cigna Medicare	$36.90
Rate for Payer: Medicaid All Medicaid	$37.72
Rate for Payer: Medicare All Medicare	$28.70
Rate for Payer: Monida Allegiance	$38.95
Rate for Payer: Monida First Choice Health	$39.77
Rate for Payer: Monida Montana Health Co-op	$38.95
Rate for Payer: Monida PacificSource	$38.95

BETA-2 GLYCOPROTEIN 1 AB, IGM (163908)

Facility

$87.00

Service Code	CPT 86146
Hospital Charge Code	4000049
Hospital Revenue Code	307
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$82.65
Rate for Payer: Aetna Medicare	$78.30
Rate for Payer: BCBS MT CHIP	$78.30
Rate for Payer: BCBS MT Closed Plan Network	$82.65
Rate for Payer: BCBS MT HealthLink	$78.30
Rate for Payer: BCBS MT Medicare	$78.30
Rate for Payer: BCBS MT POS	$82.65
Rate for Payer: BCBS MT Traditional	$87.00
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial	$82.65
Rate for Payer: Cigna Medicare	$78.30
Rate for Payer: Medicaid All Medicaid	$80.04
Rate for Payer: Medicare All Medicare	$60.90
Rate for Payer: Monida Allegiance	$82.65
Rate for Payer: Monida First Choice Health	$84.39
Rate for Payer: Monida Montana Health Co-op	$82.65
Rate for Payer: Monida PacificSource	$82.65

BETA-2 GLYCOPROTEIN 1 AB, IGM (163908)

Facility

$87.00

Service Code	CPT 86146
Hospital Charge Code	4000049
Hospital Revenue Code	307
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$82.65
Rate for Payer: Aetna Medicare	$78.30
Rate for Payer: BCBS MT CHIP	$78.30
Rate for Payer: BCBS MT Closed Plan Network	$82.65
Rate for Payer: BCBS MT HealthLink	$78.30
Rate for Payer: BCBS MT Medicare	$78.30
Rate for Payer: BCBS MT POS	$82.65
Rate for Payer: BCBS MT Traditional	$87.00
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial	$82.65
Rate for Payer: Cigna Medicare	$78.30
Rate for Payer: Medicaid All Medicaid	$80.04
Rate for Payer: Medicare All Medicare	$60.90
Rate for Payer: Monida Allegiance	$82.65
Rate for Payer: Monida First Choice Health	$84.39
Rate for Payer: Monida Montana Health Co-op	$82.65
Rate for Payer: Monida PacificSource	$82.65

BETA 2 MICROGLOBULIN (010181)

Facility

$45.00

Service Code	CPT 82232
Hospital Charge Code	4082232
Hospital Revenue Code	301
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$42.75
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCBS MT CHIP	$40.50
Rate for Payer: BCBS MT Closed Plan Network	$42.75
Rate for Payer: BCBS MT HealthLink	$40.50
Rate for Payer: BCBS MT Medicare	$40.50
Rate for Payer: BCBS MT POS	$42.75
Rate for Payer: BCBS MT Traditional	$45.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial	$42.75
Rate for Payer: Cigna Medicare	$40.50
Rate for Payer: Medicaid All Medicaid	$41.40
Rate for Payer: Medicare All Medicare	$31.50
Rate for Payer: Monida Allegiance	$42.75
Rate for Payer: Monida First Choice Health	$43.65
Rate for Payer: Monida Montana Health Co-op	$42.75
Rate for Payer: Monida PacificSource	$42.75

BETA 2 MICROGLOBULIN (010181)

Facility

$45.00

Service Code	CPT 82232
Hospital Charge Code	4082232
Hospital Revenue Code	301
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$42.75
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCBS MT CHIP	$40.50
Rate for Payer: BCBS MT Closed Plan Network	$42.75
Rate for Payer: BCBS MT HealthLink	$40.50
Rate for Payer: BCBS MT Medicare	$40.50
Rate for Payer: BCBS MT POS	$42.75
Rate for Payer: BCBS MT Traditional	$45.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial	$42.75
Rate for Payer: Cigna Medicare	$40.50
Rate for Payer: Medicaid All Medicaid	$41.40
Rate for Payer: Medicare All Medicare	$31.50
Rate for Payer: Monida Allegiance	$42.75
Rate for Payer: Monida First Choice Health	$43.65
Rate for Payer: Monida Montana Health Co-op	$42.75
Rate for Payer: Monida PacificSource	$42.75

BETA-2 TRANSFERRIN (829030)

Facility

$361.00

Service Code	CPT 86335
Hospital Charge Code	4086335
Hospital Revenue Code	307
Min. Negotiated Rate	$252.70
Max. Negotiated Rate	$361.00
Rate for Payer: Aetna Commercial	$342.95
Rate for Payer: Aetna Medicare	$324.90
Rate for Payer: BCBS MT CHIP	$324.90
Rate for Payer: BCBS MT Closed Plan Network	$342.95
Rate for Payer: BCBS MT HealthLink	$324.90
Rate for Payer: BCBS MT Medicare	$324.90
Rate for Payer: BCBS MT POS	$342.95
Rate for Payer: BCBS MT Traditional	$361.00
Rate for Payer: Cash Price	$324.90
Rate for Payer: Cigna Commercial	$342.95
Rate for Payer: Cigna Medicare	$324.90
Rate for Payer: Medicaid All Medicaid	$332.12
Rate for Payer: Medicare All Medicare	$252.70
Rate for Payer: Monida Allegiance	$342.95
Rate for Payer: Monida First Choice Health	$350.17
Rate for Payer: Monida Montana Health Co-op	$342.95
Rate for Payer: Monida PacificSource	$342.95

BETA-2 TRANSFERRIN (829030)

Facility

$361.00

Service Code	CPT 86335
Hospital Charge Code	4086335
Hospital Revenue Code	307
Min. Negotiated Rate	$252.70
Max. Negotiated Rate	$361.00
Rate for Payer: Aetna Commercial	$342.95
Rate for Payer: Aetna Medicare	$324.90
Rate for Payer: BCBS MT CHIP	$324.90
Rate for Payer: BCBS MT Closed Plan Network	$342.95
Rate for Payer: BCBS MT HealthLink	$324.90
Rate for Payer: BCBS MT Medicare	$324.90
Rate for Payer: BCBS MT POS	$342.95
Rate for Payer: BCBS MT Traditional	$361.00
Rate for Payer: Cash Price	$324.90
Rate for Payer: Cigna Commercial	$342.95
Rate for Payer: Cigna Medicare	$324.90
Rate for Payer: Medicaid All Medicaid	$332.12
Rate for Payer: Medicare All Medicare	$252.70
Rate for Payer: Monida Allegiance	$342.95
Rate for Payer: Monida First Choice Health	$350.17
Rate for Payer: Monida Montana Health Co-op	$342.95
Rate for Payer: Monida PacificSource	$342.95

BETA-HYDROXYBUTYRATE (503610)

Facility

$215.00

Service Code	CPT 82010
Hospital Charge Code	4082010
Hospital Revenue Code	300
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$204.25
Rate for Payer: Aetna Medicare	$193.50
Rate for Payer: BCBS MT CHIP	$193.50
Rate for Payer: BCBS MT Closed Plan Network	$204.25
Rate for Payer: BCBS MT HealthLink	$193.50
Rate for Payer: BCBS MT Medicare	$193.50
Rate for Payer: BCBS MT POS	$204.25
Rate for Payer: BCBS MT Traditional	$215.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cigna Commercial	$204.25
Rate for Payer: Cigna Medicare	$193.50
Rate for Payer: Medicaid All Medicaid	$197.80
Rate for Payer: Medicare All Medicare	$150.50
Rate for Payer: Monida Allegiance	$204.25
Rate for Payer: Monida First Choice Health	$208.55
Rate for Payer: Monida Montana Health Co-op	$204.25
Rate for Payer: Monida PacificSource	$204.25

BETA-HYDROXYBUTYRATE (503610)

Facility

$215.00

Service Code	CPT 82010
Hospital Charge Code	4082010
Hospital Revenue Code	300
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$204.25
Rate for Payer: Aetna Medicare	$193.50
Rate for Payer: BCBS MT CHIP	$193.50
Rate for Payer: BCBS MT Closed Plan Network	$204.25
Rate for Payer: BCBS MT HealthLink	$193.50
Rate for Payer: BCBS MT Medicare	$193.50
Rate for Payer: BCBS MT POS	$204.25
Rate for Payer: BCBS MT Traditional	$215.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cigna Commercial	$204.25
Rate for Payer: Cigna Medicare	$193.50
Rate for Payer: Medicaid All Medicaid	$197.80
Rate for Payer: Medicare All Medicare	$150.50
Rate for Payer: Monida Allegiance	$204.25
Rate for Payer: Monida First Choice Health	$208.55
Rate for Payer: Monida Montana Health Co-op	$204.25
Rate for Payer: Monida PacificSource	$204.25

BETAMETHASONE INJ [6 MG/ML] NF

Facility

$135.00

Service Code	HCPCS J0702
Hospital Charge Code	3000051
Hospital Revenue Code	259
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$128.25
Rate for Payer: Aetna Medicare	$121.50
Rate for Payer: BCBS MT CHIP	$121.50
Rate for Payer: BCBS MT Closed Plan Network	$128.25
Rate for Payer: BCBS MT HealthLink	$121.50
Rate for Payer: BCBS MT Medicare	$121.50
Rate for Payer: BCBS MT POS	$128.25
Rate for Payer: BCBS MT Traditional	$135.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial	$128.25
Rate for Payer: Cigna Medicare	$121.50
Rate for Payer: Medicaid All Medicaid	$124.20
Rate for Payer: Medicare All Medicare	$94.50
Rate for Payer: Monida Allegiance	$128.25
Rate for Payer: Monida First Choice Health	$130.95
Rate for Payer: Monida Montana Health Co-op	$128.25
Rate for Payer: Monida PacificSource	$128.25

BETAMETHASONE INJ [6 MG/ML] NF

Facility

$135.00

Service Code	HCPCS J0702
Hospital Charge Code	3000051
Hospital Revenue Code	259
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$128.25
Rate for Payer: Aetna Medicare	$121.50
Rate for Payer: BCBS MT CHIP	$121.50
Rate for Payer: BCBS MT Closed Plan Network	$128.25
Rate for Payer: BCBS MT HealthLink	$121.50
Rate for Payer: BCBS MT Medicare	$121.50
Rate for Payer: BCBS MT POS	$128.25
Rate for Payer: BCBS MT Traditional	$135.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial	$128.25
Rate for Payer: Cigna Medicare	$121.50
Rate for Payer: Medicaid All Medicaid	$124.20
Rate for Payer: Medicare All Medicare	$94.50
Rate for Payer: Monida Allegiance	$128.25
Rate for Payer: Monida First Choice Health	$130.95
Rate for Payer: Monida Montana Health Co-op	$128.25
Rate for Payer: Monida PacificSource	$128.25

BILE ACIDS TOTAL

Facility

$150.00

Service Code	CPT 82239
Hospital Charge Code	4087922
Hospital Revenue Code	300
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare	$135.00
Rate for Payer: BCBS MT CHIP	$135.00
Rate for Payer: BCBS MT Closed Plan Network	$142.50
Rate for Payer: BCBS MT HealthLink	$135.00
Rate for Payer: BCBS MT Medicare	$135.00
Rate for Payer: BCBS MT POS	$142.50
Rate for Payer: BCBS MT Traditional	$150.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial	$142.50
Rate for Payer: Cigna Medicare	$135.00
Rate for Payer: Medicaid All Medicaid	$138.00
Rate for Payer: Medicare All Medicare	$105.00
Rate for Payer: Monida Allegiance	$142.50
Rate for Payer: Monida First Choice Health	$145.50
Rate for Payer: Monida Montana Health Co-op	$142.50
Rate for Payer: Monida PacificSource	$142.50

BILE ACIDS TOTAL

Facility

$150.00

Service Code	CPT 82239
Hospital Charge Code	4087922
Hospital Revenue Code	300
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare	$135.00
Rate for Payer: BCBS MT CHIP	$135.00
Rate for Payer: BCBS MT Closed Plan Network	$142.50
Rate for Payer: BCBS MT HealthLink	$135.00
Rate for Payer: BCBS MT Medicare	$135.00
Rate for Payer: BCBS MT POS	$142.50
Rate for Payer: BCBS MT Traditional	$150.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial	$142.50
Rate for Payer: Cigna Medicare	$135.00
Rate for Payer: Medicaid All Medicaid	$138.00
Rate for Payer: Medicare All Medicare	$105.00
Rate for Payer: Monida Allegiance	$142.50
Rate for Payer: Monida First Choice Health	$145.50
Rate for Payer: Monida Montana Health Co-op	$142.50
Rate for Payer: Monida PacificSource	$142.50

BILIRUBIN, TOTAL

Facility

$61.00

Service Code	CPT 82247
Hospital Charge Code	4082247
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$57.95
Rate for Payer: Aetna Medicare	$54.90
Rate for Payer: BCBS MT CHIP	$54.90
Rate for Payer: BCBS MT Closed Plan Network	$57.95
Rate for Payer: BCBS MT HealthLink	$54.90
Rate for Payer: BCBS MT Medicare	$54.90
Rate for Payer: BCBS MT POS	$57.95
Rate for Payer: BCBS MT Traditional	$61.00
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: Cigna Medicare	$54.90
Rate for Payer: Medicaid All Medicaid	$56.12
Rate for Payer: Medicare All Medicare	$42.70
Rate for Payer: Monida Allegiance	$57.95
Rate for Payer: Monida First Choice Health	$59.17
Rate for Payer: Monida Montana Health Co-op	$57.95
Rate for Payer: Monida PacificSource	$57.95

BILIRUBIN, TOTAL

Facility

$61.00

Service Code	CPT 82247
Hospital Charge Code	4082247
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$57.95
Rate for Payer: Aetna Medicare	$54.90
Rate for Payer: BCBS MT CHIP	$54.90
Rate for Payer: BCBS MT Closed Plan Network	$57.95
Rate for Payer: BCBS MT HealthLink	$54.90
Rate for Payer: BCBS MT Medicare	$54.90
Rate for Payer: BCBS MT POS	$57.95
Rate for Payer: BCBS MT Traditional	$61.00
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: Cigna Medicare	$54.90
Rate for Payer: Medicaid All Medicaid	$56.12
Rate for Payer: Medicare All Medicare	$42.70
Rate for Payer: Monida Allegiance	$57.95
Rate for Payer: Monida First Choice Health	$59.17
Rate for Payer: Monida Montana Health Co-op	$57.95
Rate for Payer: Monida PacificSource	$57.95

BIOFIRE GI PANEL RVMC

Facility

$1,029.00

Service Code	CPT 87507
Hospital Charge Code	4087895
Hospital Revenue Code	300
Min. Negotiated Rate	$720.30
Max. Negotiated Rate	$1,029.00
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare	$926.10
Rate for Payer: BCBS MT CHIP	$926.10
Rate for Payer: BCBS MT Closed Plan Network	$977.55
Rate for Payer: BCBS MT HealthLink	$926.10
Rate for Payer: BCBS MT Medicare	$926.10
Rate for Payer: BCBS MT POS	$977.55
Rate for Payer: BCBS MT Traditional	$1,029.00
Rate for Payer: Cash Price	$926.10
Rate for Payer: Cigna Commercial	$977.55
Rate for Payer: Cigna Medicare	$926.10
Rate for Payer: Medicaid All Medicaid	$946.68
Rate for Payer: Medicare All Medicare	$720.30
Rate for Payer: Monida Allegiance	$977.55
Rate for Payer: Monida First Choice Health	$998.13
Rate for Payer: Monida Montana Health Co-op	$977.55
Rate for Payer: Monida PacificSource	$977.55

BIOFIRE GI PANEL RVMC

Facility

$1,029.00

Service Code	CPT 87507
Hospital Charge Code	4087895
Hospital Revenue Code	300
Min. Negotiated Rate	$720.30
Max. Negotiated Rate	$1,029.00
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare	$926.10
Rate for Payer: BCBS MT CHIP	$926.10
Rate for Payer: BCBS MT Closed Plan Network	$977.55
Rate for Payer: BCBS MT HealthLink	$926.10
Rate for Payer: BCBS MT Medicare	$926.10
Rate for Payer: BCBS MT POS	$977.55
Rate for Payer: BCBS MT Traditional	$1,029.00
Rate for Payer: Cash Price	$926.10
Rate for Payer: Cigna Commercial	$977.55
Rate for Payer: Cigna Medicare	$926.10
Rate for Payer: Medicaid All Medicaid	$946.68
Rate for Payer: Medicare All Medicare	$720.30
Rate for Payer: Monida Allegiance	$977.55
Rate for Payer: Monida First Choice Health	$998.13
Rate for Payer: Monida Montana Health Co-op	$977.55
Rate for Payer: Monida PacificSource	$977.55

BIOPSY-INCISION SNGL LESION-11106

Facility

$187.00

Service Code	CPT 11106
Hospital Charge Code	8011100
Hospital Revenue Code	521
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$168.30
Rate for Payer: BCBS MT CHIP	$168.30
Rate for Payer: BCBS MT Closed Plan Network	$177.65
Rate for Payer: BCBS MT HealthLink	$168.30
Rate for Payer: BCBS MT Medicare	$168.30
Rate for Payer: BCBS MT POS	$177.65
Rate for Payer: BCBS MT Traditional	$187.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial	$177.65
Rate for Payer: Cigna Medicare	$168.30
Rate for Payer: Medicaid All Medicaid	$172.04
Rate for Payer: Medicare All Medicare	$130.90
Rate for Payer: Monida Allegiance	$177.65
Rate for Payer: Monida First Choice Health	$181.39
Rate for Payer: Monida Montana Health Co-op	$177.65
Rate for Payer: Monida PacificSource	$177.65

BIOPSY-INCISION SNGL LESION-11106

Facility

$187.00

Service Code	CPT 11106
Hospital Charge Code	8011100
Hospital Revenue Code	521
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$168.30
Rate for Payer: BCBS MT CHIP	$168.30
Rate for Payer: BCBS MT Closed Plan Network	$177.65
Rate for Payer: BCBS MT HealthLink	$168.30
Rate for Payer: BCBS MT Medicare	$168.30
Rate for Payer: BCBS MT POS	$177.65
Rate for Payer: BCBS MT Traditional	$187.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial	$177.65
Rate for Payer: Cigna Medicare	$168.30
Rate for Payer: Medicaid All Medicaid	$172.04
Rate for Payer: Medicare All Medicare	$130.90
Rate for Payer: Monida Allegiance	$177.65
Rate for Payer: Monida First Choice Health	$181.39
Rate for Payer: Monida Montana Health Co-op	$177.65
Rate for Payer: Monida PacificSource	$177.65

BIOPSY LIP

Facility

$356.00

Service Code	CPT 40490
Hospital Charge Code	8040490
Hospital Revenue Code	521
Min. Negotiated Rate	$249.20
Max. Negotiated Rate	$356.00
Rate for Payer: Aetna Commercial	$338.20
Rate for Payer: Aetna Medicare	$320.40
Rate for Payer: BCBS MT CHIP	$320.40
Rate for Payer: BCBS MT Closed Plan Network	$338.20
Rate for Payer: BCBS MT HealthLink	$320.40
Rate for Payer: BCBS MT Medicare	$320.40
Rate for Payer: BCBS MT POS	$338.20
Rate for Payer: BCBS MT Traditional	$356.00
Rate for Payer: Cash Price	$320.40
Rate for Payer: Cigna Commercial	$338.20
Rate for Payer: Cigna Medicare	$320.40
Rate for Payer: Medicaid All Medicaid	$327.52
Rate for Payer: Medicare All Medicare	$249.20
Rate for Payer: Monida Allegiance	$338.20
Rate for Payer: Monida First Choice Health	$345.32
Rate for Payer: Monida Montana Health Co-op	$338.20
Rate for Payer: Monida PacificSource	$338.20

BIOPSY LIP

Facility

$356.00

Service Code	CPT 40490
Hospital Charge Code	8040490
Hospital Revenue Code	521
Min. Negotiated Rate	$249.20
Max. Negotiated Rate	$356.00
Rate for Payer: Aetna Commercial	$338.20
Rate for Payer: Aetna Medicare	$320.40
Rate for Payer: BCBS MT CHIP	$320.40
Rate for Payer: BCBS MT Closed Plan Network	$338.20
Rate for Payer: BCBS MT HealthLink	$320.40
Rate for Payer: BCBS MT Medicare	$320.40
Rate for Payer: BCBS MT POS	$338.20
Rate for Payer: BCBS MT Traditional	$356.00
Rate for Payer: Cash Price	$320.40
Rate for Payer: Cigna Commercial	$338.20
Rate for Payer: Cigna Medicare	$320.40
Rate for Payer: Medicaid All Medicaid	$327.52
Rate for Payer: Medicare All Medicare	$249.20
Rate for Payer: Monida Allegiance	$338.20
Rate for Payer: Monida First Choice Health	$345.32
Rate for Payer: Monida Montana Health Co-op	$338.20
Rate for Payer: Monida PacificSource	$338.20

BIOPSY LYMPH NODE

Facility

$630.00

Service Code	CPT 38500
Hospital Charge Code	8038500
Hospital Revenue Code	521
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare	$567.00
Rate for Payer: BCBS MT CHIP	$567.00
Rate for Payer: BCBS MT Closed Plan Network	$598.50
Rate for Payer: BCBS MT HealthLink	$567.00
Rate for Payer: BCBS MT Medicare	$567.00
Rate for Payer: BCBS MT POS	$598.50
Rate for Payer: BCBS MT Traditional	$630.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cigna Commercial	$598.50
Rate for Payer: Cigna Medicare	$567.00
Rate for Payer: Medicaid All Medicaid	$579.60
Rate for Payer: Medicare All Medicare	$441.00
Rate for Payer: Monida Allegiance	$598.50
Rate for Payer: Monida First Choice Health	$611.10
Rate for Payer: Monida Montana Health Co-op	$598.50
Rate for Payer: Monida PacificSource	$598.50

BIOPSY LYMPH NODE

Facility

$630.00

Service Code	CPT 38500
Hospital Charge Code	8038500
Hospital Revenue Code	521
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare	$567.00
Rate for Payer: BCBS MT CHIP	$567.00
Rate for Payer: BCBS MT Closed Plan Network	$598.50
Rate for Payer: BCBS MT HealthLink	$567.00
Rate for Payer: BCBS MT Medicare	$567.00
Rate for Payer: BCBS MT POS	$598.50
Rate for Payer: BCBS MT Traditional	$630.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cigna Commercial	$598.50
Rate for Payer: Cigna Medicare	$567.00
Rate for Payer: Medicaid All Medicaid	$579.60
Rate for Payer: Medicare All Medicare	$441.00
Rate for Payer: Monida Allegiance	$598.50
Rate for Payer: Monida First Choice Health	$611.10
Rate for Payer: Monida Montana Health Co-op	$598.50
Rate for Payer: Monida PacificSource	$598.50

BIOPSY-PUNCH SINGLE LESION-11104

Facility

$208.00

Service Code	CPT 11104
Hospital Charge Code	8011104
Hospital Revenue Code	521
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare	$187.20
Rate for Payer: BCBS MT CHIP	$187.20
Rate for Payer: BCBS MT Closed Plan Network	$197.60
Rate for Payer: BCBS MT HealthLink	$187.20
Rate for Payer: BCBS MT Medicare	$187.20
Rate for Payer: BCBS MT POS	$197.60
Rate for Payer: BCBS MT Traditional	$208.00
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial	$197.60
Rate for Payer: Cigna Medicare	$187.20
Rate for Payer: Medicaid All Medicaid	$191.36
Rate for Payer: Medicare All Medicare	$145.60
Rate for Payer: Monida Allegiance	$197.60
Rate for Payer: Monida First Choice Health	$201.76
Rate for Payer: Monida Montana Health Co-op	$197.60
Rate for Payer: Monida PacificSource	$197.60

Know your out-of-pocket cost for care.

All Charges